Visual acuity after acute primary angle closure and considerations for primary lens extraction

Area of Science:

• Ophthalmology
• Clinical Medicine

Background:

• Acute primary angle closure (APAC) is a condition where primary lens extraction is often recommended.
• The necessity of lens extraction in all APAC cases remains debated.

Purpose of the Study:

• To evaluate the visual acuity (VA) of eyes with APAC shortly after the acute episode resolves.
• To assess the appropriateness of primary lens extraction in managing APAC based on early visual outcomes.

Main Methods:

• Prospective observational case series of 135 APAC patients.
• Measurement of Snellen visual acuity (VA) and subjective refraction after resolution of acute symptoms.
• Data collected as part of a randomized controlled trial comparing phacoemulsification and laser iridotomy.

Main Results:

• Over half of APAC eyes (50.4%) achieved good visual acuity (6/12 or better) within days of resolution.
• More than a quarter of eyes had VA of 6/7.5 or better.
• Poor VA was linked to symptom duration and time to APAC resolution, not sex, age, or presenting intraocular pressure.

Conclusions:

• A significant proportion of eyes with APAC demonstrate good visual acuity shortly after the acute phase.
• The routine use of lens extraction for all APAC cases requires further consideration, particularly in eyes with favorable early visual outcomes.